Personal protection insurance (PIP) benefits; MCL 500.3157(15)(f); The multiple-procedure payment reduction (MPPR) Medicare rule; Favot v Brown

Concluding that the outcome here was governed by Favot, the court held that “the MPPR may be applied in determining the amount of PIP benefits payable by” defendant-no-fault insurer for plaintiffs-providers’ MRI services. This interlocutory appeal concerned payment of PIP benefits. “Defendant provided no-fault PIP coverage to a nonparty insured[,]” who sustained injuries due to a motor vehicle accident, and received MRI services provided by plaintiffs. “In determining the amount potentially payable for those services, defendant applied the” Medicare MPPR “rule, which reduces the payable amount by a certain percentage when multiple procedures are performed during a single patient encounter. Plaintiffs brought suit in district court, seeking nonreduced payment for their services.” The district court denied defendant’s motion for partial summary disposition, and the circuit court affirmed. The dispositive issue was “whether the MPPR is a ‘limitation[] unrelated to the rates in the fee schedule’ for purposes of MCL 500.3157(15)(f), such that it cannot be used in determining the amount payable under MCL 500.3157(2).” While this appeal was pending, the court decided this question in Favot, concluding “the Medicare rules at issue in that case—which included the MPPR—'are related to the fee schedule’ and ‘affect the amount Medicare would pay for the particular service, meaning they may be considered for purposes of the no-fault act.’” The lower courts here erred in ruling “otherwise (although of course, they did not have the benefit of Favot when reaching their conclusions). Favot is precedentially binding[.]” Thus, the court reversed the circuit court’s order affirming the district court’s denial of defendant’s motion, and remanded.